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A Second Womb

A NYTimes Magazine article about a psychologist working to improve the cognitive futures of premature babies by making life in NICU more like the womb

Als also encourages N.I.C.U. doctors and nurses to ensure that the babies experience long periods of near-complete darkness. At Children’s Hospital, when doctors or nurses aren’t working with a baby, the baby’s incubator is covered with a blanket to give it a chance to sleep. Als has explained to her colleagues that the babies are far more aware of their surroundings than the doctors and nurses had thought. When she and I toured the N.I.C.U., she made that point for me by gingerly lifting the corner of one of the blankets. The baby inside the incubator reacted immediately — his breathing became less stable and he shifted his position, even though he hadn’t opened his eyes. ”He knows we’re peeking,” she said.


In 2003, Als and a dozen colleagues reported on the effectiveness of a treatment program that requires doctors and nurses to deliver food and care on a schedule that gives the infants more time to rest, relax and sleep. The care was organized around the needs of the individual infants and families, instead of the work schedules of the doctors and nurses. The findings were remarkable. The babies moved more quickly from intravenous to oral feeding. They spent less time in the N.I.C.U. and had fewer infections, better motor skills and a better ability to focus their attention. They grew faster. And their families displayed less stress and had better relationships with their children. The study provided ”clear evidence for the effectiveness of individualized developmental care,” the researchers concluded.


In a follow-up study last year, Als and her team studied the brain development of premature kids and found further evidence of enhanced brain function and structure in children in the individualized program. There were more neural connections, and those connections more closely paralleled the wiring that would have developed if the babies had remained in the womb for nine months.

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Michael Tinkler

posted August 14, 2005 at 10:38 am

One of the key insights here seems to be this one: Als has explained to her colleagues that the babies are far more aware of their surroundings than the doctors and nurses had thought.
Does anyone else remember hearing people intone on educational t.v. that surgeons operated on infants without aneesthesia b/c they had less developed pain receptors? I hope they were saying that as a happy lie to cover their fear of killing the baby with anesthesia, but I’m not sure.

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posted August 14, 2005 at 10:59 am

I worked as a medical technician for over 4 years in the NICU at a world famous hospital. I also worked as a Critical Care Technician (part of the anesthesia team) for an additional 1.5 years in the O.R. of the same hospital. I can verify that it was, at that time (late 70’s, early 80’s), standard practice to operate on infants without any anesthesia. They would paralyze them with drugs, but not any pain killers. They gave me both lines, that 1) the baby doesn’t feel pain the way you and I do, and 2) it was too dangerous to give them painkillers or to put them to sleep. I never believed it then, and I don’t believe it now. Rather, I think it is a mental evasion of the fact that so much of what they do causes extreme pain to the babies that they couldn’t do it if they allowed themselves to believe it caused so much pain.

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posted August 14, 2005 at 3:10 pm

My youngest was born at 34 weeks and spent time in the NICU. The thing that struck me the most was that she was able to differentiate between me and the staff of the NICU pretty much from the day she was born. Whenever anyone on the staff touched her or talked around her, she would cry. As soon as I spoke to her or my husband spoke to her, she would calm down almost immediately. I assume that was because she could recognize our voices from when she was in my womb.

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